Somatostatin Analogues according to Ki67 index in neuroendocrine tumours: an observational retrospective-prospective analysis from real life
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Antongiulio Faggiano1, Anna Chiara Carratù2, Elia Guadagno3, Salvatore Tafuto4, Fabiana Tatangelo5, Ferdinando Riccardi6, Carmela Mocerino6, Giovannella Palmieri7, Vincenzo Damiano7, Roberta Siciliano8, Silvana Leo9, Annamaria Mauro9, Lucia Franca Tozzi10, Claudia Battista11, Gaetano De Rosa3 and Annamaria Colao2
1 Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumouri “Fondazione G. Pascale” IRCCS, Napoli, Italy
2 Endocrinology Unit, Department of Clinical Medicine and Surgery, Università di Napoli Federico II, Napoli, Italy
3 Pathology Unit, Department of Advanced Biomedical Sciences, Università di Napoli Federico II, Napoli, Italy
4 Medical Oncology Unit, Istituto Nazionale per lo studio e la cura dei tumouri “Fondazione G. Pascale” IRCCS, Napoli, Italy
5 Pathology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumouri “Fondazione G. Pascale” IRCCS, Napoli, Italy
6 Oncology Unit, AORN Cardarelli, Napoli, Italy
7 Oncology Unit, Department of Clinical Medicine and Surgery, Università di Napoli Federico II, Napoli, Italy
8 Department of Industrial Engeenering, Università di Napoli Federico II, Napoli, Italy
9 Oncology Unit, Ospedale Civico, Lecce, Italy
10 Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
11 Endocrinology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
Antongiulio Faggiano, email:
Keywords: neuroendocrine tumours, Ki67 index, octreotide, lanreotide, somatostatin analogues
Received: August 04, 2015 Accepted: December 10, 2015 Published: December 19, 2015
Somatostatin analogues (SSAs) have shown limited and variable antiproliferative effects in neuroendocrine tumours (NETs). Whether tumour control by SSAs depends on grading based on the 2010 WHO NET classification is still unclear. The aim of this study is to evaluate the efficacy of long-acting SSAs in NETs according to Ki67 index.
An observational Italian multicentre study was designed to collect data in patients with gastro-entero-pancreatic or thoracic NETs under SSA treatment. Both retrospective and prospective data were included and they were analysed in line with Ki67 index, immunohistochemically evaluated in tumour samples and graded according to WHO classification (G1 = Ki67 index 0-2%, G2 = Ki67 index 3-20%, G3 = Ki67 index > 20%).
Among 601 patients with NET, 140 with a histologically confirmed gastro-entero-pancreatic or thoracic NET or NET with unknown primary were treated with lanreotide autogel or octreotide LAR. An objective tumour response was observed in 11%, stability in 58% and progression in 31%. Objective response and tumour stability were not significantly different between G1 and G2 NETs. Progression free survival was longer but not significantly different in G1 than G2 NETs (median: 89 vs 43 months, p = 0.15). The median PFS was significantly longer in NETs showing Ki67 < 5% than in those showing Ki67 ≥5% (89 vs 35 months, p = 0.005).
SSA therapy shows significant antiproliferative effects in well differentiated low/intermediate-proliferating NETs, not only G1 but also in G2 type. A Ki67 index of 5% seems to work better than 3% to select the best candidates for SSA therapy.
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